Cerebral Venous Thrombosis (CVT)
Î In patients with suspected CVT, routine blood studies consisting of a
complete blood count, chemistry panel, prothrombin time, and activated
partial thromboplastin time should be performed (I-C).
Î Screening for potential prothrombotic conditions that may predispose a
person to CVT (eg, use of contraceptives, underlying inflammatory disease,
infectious process) is recommended in the initial clinical assessment (I-C).
Î Testing for prothrombotic conditions, including protein C, protein S,
or antithrombin deficiency; antiphospholipid syndrome; prothrombin
G20210A mutation; and factor V Leiden can be beneficial for the
management of patients with CVT. Testing for protein C, protein S, and
antithrombin deficiency is generally indicated 2-4 weeks after completion
of anticoagulation. There is a very limited value of testing in the acute
setting or in patients taking warfarin (IIa-B).
Î In patients with provoked CVT (associated with a transient risk factor),
vitamin K antagonists with a target INR of 2.0-3.0 may be continued for
3-6 months (IIb-C).
Î In patients with unprovoked CVT, vitamin K antagonists may be continued
for 6-12 months, with a target INR of 2.0-3.0 (IIb-C).
Î For patients with recurrent CVT, VTE after CVT, or first CVT with severe
thrombophilia (ie, homozygous prothrombin G20210A; homozygous
factor V Leiden; deficiencies of protein C, protein S, or antithrombin;
combined thrombophilia defects; or antiphospholipid syndrome), indefinite
anticoagulation with a target INR of 2.0-3.0 may be considered (IIb-C).
Î For women with CVT during pregnancy, LMWH in full anticoagulant doses
should be continued throughout pregnancy, and LMWH or vitamin K
antagonist with a target INR of 2.0-3.0 should be continued for ≥6 weeks
postpartum (for a total minimum duration of therapy of 6 months) (I-C).
Î It is reasonable to advise women with a history of CVT that future
pregnancy is not contraindicated. Further investigations regarding
the underlying cause and a formal consultation with a hematologist or
maternal-fetal medicine specialist are reasonable (IIa-B).
Î It is reasonable to treat acute CVT during pregnancy with full-dose LMWH
rather than unfractionated heparin (IIa-C).
Î For women with a history of CVT, prophylaxis with LMWH during future
pregnancies and the postpartum period is reasonable (IIa-C).
